Schiodt F V, Atillasoy E, Shakil A O, Schiff E R, Caldwell C, Kowdley K V, Stribling R, Crippin J S, Flamm S, Somberg K A, Rosen H, McCashland T M, Hay J E, Lee W M
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Liver Transpl Surg. 1999 Jan;5(1):29-34. doi: 10.1002/lt.500050102.
Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period from July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver transplant centers). Data on the patients included age, hepatic coma grade on admission, presumed cause, transplantation, and outcome. Among 295 patients, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, and 99 (34%) died without undergoing transplantation. Ninety-two of 121 patients (76%) survived 1 year after transplantation. Acetaminophen overdose was the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%). Spontaneous survival rates were highest for patients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients). The transplantation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%). Age did not differ between survivors and nonsurvivors, perhaps reflecting a selection bias for patients transferred to liver transplant centers. Coma grade on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate. These findings on retrospectively studied patients from the United States differ from those previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country.
关于美国急性肝衰竭（ALF）的信息较少。我们回顾性收集了1994年7月至1996年6月这两年期间来自13家医院（12家肝移植中心）的所有ALF病例的人口统计学数据。患者数据包括年龄、入院时的肝昏迷分级、推测病因、移植情况及转归。295例患者中，74例（25%）自发存活，121例（41%）接受了移植，99例（34%）未接受移植死亡。121例接受移植的患者中有92例（76%）移植后存活1年。对乙酰氨基酚过量是最常见的病因（60例患者；20%），其次是隐源性/非甲非乙非丙型肝炎（NANBNC；15%）、特异质性药物反应（12%）、乙型肝炎（10%）和甲型肝炎（7%）。对乙酰氨基酚过量患者（57%）和甲型肝炎患者（40%）的自发存活率最高，而威尔逊病患者（18例中无存活者）的自发存活率最低。威尔逊病患者的移植率最高（18例中有17例；94%），自身免疫性肝炎患者（29%）和对乙酰氨基酚过量患者（12%）的移植率最低。存活者与非存活者之间的年龄无差异，这可能反映了转至肝移植中心的患者存在选择偏倚。入院时的昏迷分级不是转归的显著决定因素，但在影响存活率和移植率方面呈一种趋势。这些对美国患者进行回顾性研究的结果与之前在英国和法国收集的结果不同，凸显了对各国趋势进行进一步研究的必要性。
